A Case Of Appendiceal Bleeding In Adult

Odette Eden L. Salazar, M.D.1, Edgar Allan Bongat, M.D 2, Renelene A. Macabeo, M.D.3
1 Internal Medicine resident – in-training, Our Lady of Lourdes Hospital, Sta. Mesa, Manila 2 Gastroenterologist, Our Lady of Lourdes Hospital, Sta. Mesa, Manila 3 Cardiologist, Our Lady of Lourdes Hospital, Sta. Mesa, Manila

Background: Appendiceal bleeding is a very rare disease seldomly reported in the literature and which accounts 0.02% of the worldwide population and has a higher predominance in men and elderly population. The bleeding can be caused by benign erosion into the artery, ulcers, carcinoid tumors, lymphoma and angiodysplasia. Colonoscopy is the initial imaging modality that is helpful to diagnose appendiceal bleeding. Considering the prevalence of this disease which affect a 34-year old patient and low number of cases documented and published, this case is considered to be reportable.

Objectives: This case report aims to present a rare case of appendiceal bleeding in a 34-year old, male, with no known co-morbidities, initially presenting as hematochezia

Clinical Presentation: This is a case of a 34-year old, male, known to have no co-morbidities initially presenting with hematochezia with no other associated gastrointestinal symptoms. Patient denies frequent use of non-steroidal anti-inflammatory drug and herbal medication. He underwent colonoscopy showing fresh blood and blood clots at the cecum which later on known to be originating from the appendiceal orifice. Whole abdominal CT scan was further requested post colonoscopy revealing prominent sized appendix and sigmoid diverticulosis. CT scan findings prompted referral with Surgery service. Appendectomy was done revealing diagnoses: 1. Acute appendicitis with periappendicitis 2. Fibrocollagenous and fibroadipose tissue with congestion, focal acute on chronic inflammation and focal hemorrhage. 3. Fibroadipose and fibrocollagenous tissue, with congestion, and focal hemorrhage. Patient was discharged clinically stable.

Conclusion: Performing colonoscopy in patient with painless hematochezia is warranted due to the numbered causes of origin. In colonoscopy, the location can be determined and the severity of bleeding can be noted. Bleeding source was determined and addressed by surgical intervention. It is therefore recommended that in all patients presenting with hematochezia especially in young patients, a bleeding source from the appendix should be considered.

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